14-0000

104-10110- 10291 2 ~ [2025 RELEASE UNDER THE PRESIDENT JOHN Fe KENNEDY ASSASSINATION RECORDS SOG. 1992

_ E oe NOTIFICATION ‘OF ES.AAL SHMENT OR CANCELLATION
at cls OF OFFICIAL COVER BACKSTOP

8S NUM

BE
UOS- 26-3138 RETURN TO CIA

BASIC COVER PROVIDED oan Kop a
EFFECTIVE DATE — FORM 3254

OPERATIONAL COVER PROVIDED (HHB 20-7)

FoR TDY OTHER (Speci fy) . SUBMIT FORM 642 IMMEDIATELY TO- CHANGE | TELEPHONE

LIMITATION CATEGORY, TO ATEGORY _
(HHB 20-7) ;

SUBMIT FORM 642 IMMEDIATELY TO CHANGE, TELEPHONE
LIMITATION CATEGORY TO CATEGORY
(HHB 20-7) 0-5 —

FORM 3254 _T Cease) -2 TO BE ISSUED.

— “=a SUBMIT FORM 2686 FOR _
(HHB 20-11) .- 1 —~ 4 HOSPITALIZATION CARD.

: DO NOT WRITE IN- THIS BLOCK -
SUBMIT FORM 1322 FOR ANY CHANGE AFFECTING THIS

COVER. (HR 240-2e)

SUBMIT FORM 1323 FOR TRANSFERRING COVER
RESPONSIBILITY. CHR 240-2e)

| fea. CATEGORY 1! a CATEGORY 11

X {SUBMIT FORM 2688 FoR AGT HOSPITALIZATION CARD

REMARKS AND/OR COVER HISTORY . af
SJEJECT WELL Sb DENIED PGR IIIPE PLEION OF EPLOUEMT DYCEPT FOR US COVERNVENT
ATTLICATIONS.

DISTRIBUTION: ..”

COPY 1- CO/TRB OR CPD CONTROL VS/TW
COPY 2- OPERATING COMPONENT ‘
COPY 3-0S/SRD . s
COPY 4-0¢/DO/T

COPY 5. CC5-FILE

“FORM
_ 77
SS.

